Glioblastoma

Case contributed by A.Prof Frank Gaillard

Presentation

Seizure.

Patient Data

Age: 40 years
Modality: CT

Solitary rounded peripherally enhancing right temporal lobe mass with surrounding oedema. 

Modality: MRI

Solitary rounded peripherally enhancing right temporal lobe mass is centred near the grey-white matter junction, but is associated with non-enhancing high T2 thickening of the cortex anterior to it. This strongly suggests that this lesion represents a glioblastoma rather than a metastasis. 

Case Discussion

The patient went on to have a resection.

Histology

MICROSCOPIC DESCRIPTION:

Sections show fragments of a moderately hypercellular astrocytic glioma. Tumour cells show moderate nuclear and cellular pleomorphism. Scattered mitotic figures are identified. There is prominent microvascular proliferation with multilayering of atypical cells around vessel lumena. Areas of palisaded tumour necrosis are also identified.

IMMUNOHISTOCHEMISTRY:

  • GFAP: positive
  • Nestin: positive (high)
  • NogoA: positive
  • IDH-1 R132H: negative (not mutated)
  • ATRX: positive (not mutated)
  • MGMT: negative (likely methylated)
  • p53: positive
  • p16 CDKN2A: positive
  • Topoisomerase labelling index: Approximately 20%

FINAL DIAGNOSIS: Glioblastoma IDH wild-type (WHO Grade IV).

Discussion

Presence of non-enhancing tumour is an excellent way to distinguish metastases from glioblastomas. 

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Case Information

rID: 50813
Case created: 23rd Jan 2017
Last edited: 23rd Jan 2017
Inclusion in quiz mode: Included

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